Does Brixadi Make You Tired? Causes, Duration, and Management

October 7, 2025 •

5 min read

According to the medication guide, sleepiness, dizziness, and coordination problems are possible side effects of the buprenorphine injection, Brixadi. So, Does Brixadi make you tired? Yes, it can, particularly in the early stages of treatment or following a dose adjustment. This article explores why this fatigue occurs, how long it might last, and effective strategies for managing this common side effect.

Quick Summary

Brixadi, a buprenorphine injection for opioid use disorder, can cause tiredness and drowsiness by depressing the central nervous system. This side effect is often most prominent early in treatment as the body adjusts, and it can be exacerbated by other central nervous system depressants like alcohol. Patients can manage fatigue by working with their doctor to adjust the dose, avoiding interacting substances, and adopting healthy habits. It is crucial to discuss persistent or severe tiredness with a healthcare provider.

Key Points

Tiredness is a Common Side Effect: Brixadi's active ingredient, buprenorphine, can cause drowsiness and sleepiness by depressing the central nervous system.
Adjustment Period is Key: Fatigue and sleepiness are most common during the first few days after an injection or a dose change as the body acclimates to the medication.
Avoid CNS Depressants: Combining Brixadi with alcohol, benzodiazepines, or other central nervous system depressants dramatically increases the risk of severe sedation and life-threatening respiratory depression.
Listen to Your Body: Patients should not drive or operate heavy machinery until they are aware of how Brixadi affects their alertness and coordination.
Discuss Fatigue with Your Doctor: If fatigue is persistent or severe, a healthcare provider can evaluate if a dose adjustment, lifestyle change, or an underlying medical issue is the cause.
Long-term Side Effect Potential: In rare cases, long-term buprenorphine use could potentially contribute to adrenal insufficiency or liver problems, with fatigue being a symptom.
Lifestyle Management Helps: Adopting healthy habits like mild exercise, proper hydration, and a good sleep routine can help manage energy levels during treatment.

The Pharmacology of Brixadi and Buprenorphine

Brixadi is an extended-release, injectable form of buprenorphine, a partial opioid agonist used in Medication-Assisted Treatment (MAT) for opioid use disorder (OUD). To understand why Brixadi makes you tired, it is essential to look at the pharmacology of its active ingredient, buprenorphine. As a partial opioid agonist, buprenorphine binds to and partially activates the brain's opioid receptors. While this action is vital for reducing cravings and withdrawal symptoms associated with OUD, it also has a depressant effect on the central nervous system (CNS).

This CNS depression is what primarily leads to feelings of drowsiness, sleepiness, and fatigue. Buprenorphine encourages the brain to produce more of the neurotransmitter GABA, which slows down brain activity and creates a sense of relaxation. This effect is key to its therapeutic action but is also responsible for the sedative side effects. Since Brixadi is an extended-release injection, the buprenorphine is released slowly over a week or month, providing stable levels of medication in the body. This differs from daily formulations, but the underlying mechanism for sedation remains the same.

What Contributes to Brixadi-Related Fatigue?

Several factors can influence the severity and duration of tiredness experienced while on Brixadi. It is not just the medication itself, but also how the body adapts to it, and how it interacts with other substances or underlying health conditions.

Early Treatment and Dose Adjustments

Drowsiness is most commonly reported in the initial days following the first injection or when a dose is changed. This occurs as the body adjusts to the new steady state of buprenorphine. For patients new to buprenorphine, the change from illicit opioids to a therapeutic dose can also lead to an adjustment period. As the body becomes accustomed to the medication, the initial sedative effects often lessen over the next several days or weeks. However, if the fatigue persists beyond this initial period, it is important to discuss it with a healthcare provider.

Drug and Substance Interactions

One of the most significant and dangerous contributors to severe tiredness is drug interaction. Taking Brixadi with other central nervous system depressants can cause severe drowsiness, decreased awareness, and serious breathing problems, including coma or death. Substances to avoid or use with extreme caution include:

Alcohol: Drinking alcohol with Brixadi significantly increases the risk of severe sedation and respiratory depression.
Benzodiazepines: Medications like alprazolam (Xanax) or lorazepam (Ativan) can have a severe additive depressant effect.
Other Opioid Medications: Combining Brixadi with other opioids can be life-threatening.
Certain Antihistamines: Some antihistamines cause drowsiness and should be used with caution.

Underlying Medical Conditions

While less common, some medical issues can cause or worsen fatigue experienced on Brixadi. These include:

Adrenal insufficiency: Long-term opioid use can lead to the adrenal glands not producing enough cortisol, causing symptoms like fatigue, nausea, and muscle weakness.
Liver problems: Buprenorphine can affect liver function. Fatigue is a symptom of liver issues, along with other signs like jaundice and nausea. Blood tests can monitor liver health before and during treatment.

Managing Tiredness While on Brixadi Treatment

For patients experiencing manageable fatigue, several strategies can help minimize its impact on daily life. It is crucial to implement these in consultation with your healthcare provider.

Strategies for Daily Living

Avoid Dangerous Activities: Do not drive or operate heavy machinery until you know how Brixadi affects you. This is especially important during the first few days after an injection or dose change.
Lifestyle Adjustments: Regular, light exercise can boost energy levels. Maintaining good sleep hygiene and a consistent sleep schedule can also improve overall energy.
Hydration: Staying well-hydrated throughout the day can help combat fatigue.
Timing of Treatment: If you are on a weekly dosing schedule, your provider may be able to adjust the time of day your injection is administered to help with daytime sleepiness.
Nutritious Diet: Eating balanced meals can help stabilize energy levels.

Communication with Your Healthcare Provider

Your doctor is your best resource for managing side effects. If fatigue persists or interferes with your routine, consider discussing the following with your provider:

Dose Adjustment: In some cases, adjusting the dose of buprenorphine may help reduce side effects.
Medication Interactions: Review all other medications, including over-the-counter drugs, vitamins, and supplements, to identify any potential interactions that might increase drowsiness.
Underlying Issues: Your doctor can run tests to rule out or monitor for underlying conditions like adrenal or liver problems.

Brixadi vs. Other Buprenorphine Formulations

When considering medication for OUD, patients may wonder how different formulations compare regarding side effects like sedation. The primary difference lies in dosing frequency and delivery, which can impact the stability of drug levels and, in turn, the consistency of side effects.


Feature	Brixadi (Weekly/Monthly Injection)	Sublocade (Monthly Injection)	Sublingual Buprenorphine (Daily Film/Tablet)
Tiredness/Sedation	Possible, especially early on or with dose changes.	Possible, generally stable levels after initial doses.	Possible, may vary based on timing of daily dose.
Dosing Frequency	Weekly or Monthly.	Monthly.	Daily.
Flexibility	More flexible with weekly and monthly options.	Less flexible with only monthly options.	Highly flexible, can be titrated easily.
Dose Peaks	Less significant peaks than daily options, extended-release.	Stable, consistent levels throughout the month.	Potential for more pronounced peaks and troughs daily.

For some patients, the stable drug levels offered by an extended-release injection like Brixadi may lead to fewer fluctuations in energy compared to daily sublingual doses. However, the initial adjustment period can still cause noticeable sedation. Individual responses vary, and the right choice depends on personal needs, lifestyle, and medical history.

The Importance of Professional Medical Guidance

Throughout treatment with Brixadi, close collaboration with a healthcare provider is essential for safely and effectively managing side effects. Never stop or change your dose without consulting your doctor, as this can lead to uncomfortable and dangerous opioid withdrawal symptoms. If you feel that your fatigue is impacting your quality of life or safety, your doctor is equipped to help you find a solution that works for your recovery.

Conclusion: Balancing Recovery with Side Effect Management

Yes, Brixadi can make you feel tired due to its central nervous system depressant properties, a common side effect of buprenorphine. While this is often most noticeable at the beginning of treatment or with dose adjustments, it typically subsides as the body adjusts. For some, fatigue may be a sign of a more serious, though rare, underlying issue like adrenal insufficiency or liver problems. The benefits of using Brixadi for treating opioid use disorder, however, generally outweigh the temporary discomfort of side effects for most individuals. By openly communicating with a healthcare provider, avoiding contraindicated substances, and implementing healthy habits, patients can effectively manage tiredness and stay focused on their recovery journey. For more information on managing buprenorphine side effects, reputable sources like the Substance Abuse and Mental Health Services Administration (SAMHSA) offer valuable guidance.

Frequently Asked Questions

Brixadi contains buprenorphine, a partial opioid agonist that acts as a central nervous system depressant. This action can slow down brain activity, leading to feelings of drowsiness, sleepiness, and fatigue.

The fatigue and sleepiness from Brixadi are often temporary, lasting a few days to weeks, especially after an initial injection or a dose change. As your body adjusts to the medication, these side effects often diminish.

No, you should never drink alcohol or take other central nervous system depressants while on Brixadi. This combination can cause dangerous and life-threatening side effects, including severe drowsiness, respiratory depression, coma, and death.

If your fatigue is severe or persistent, you should immediately speak with your healthcare provider. They may consider adjusting your dose or evaluating for other potential causes, like underlying medical conditions or medication interactions.

Both Brixadi and other buprenorphine formulations can cause sedation. While initial doses of Brixadi may cause noticeable sleepiness, the extended-release formula can provide more stable drug levels over time compared to daily sublingual doses, which might lead to more consistent energy levels for some. Individual responses vary greatly.

In rare cases, long-term use of buprenorphine, the active ingredient in Brixadi, may be associated with adrenal insufficiency or liver problems, both of which can cause chronic fatigue. If you experience unusual or persistent tiredness, your doctor should investigate these possibilities.

For managing mild fatigue, consider adopting healthy habits such as getting regular, light exercise, prioritizing good sleep hygiene, and staying well-hydrated. Always avoid driving or operating heavy machinery until you know how the medication affects you.